Infection control is a complex endeavor. As we’ve mentioned in this column many times before, successful healthcare-associated infection control requires a multifaceted approach: hand hygiene, environmental services, antimicrobial hard and soft surfaces, basic best surgical and instrument-handling practices and more. That’s why it’s so surprising to most Americans that reusing syringes or drawing multiple doses from single-use vials of medications in healthcare settings is still a problem.

Granted, it’s only a small percentage of injections that violate CDC injection safety protocols, but it’s somewhat shocking that it happens at all. Approximately 150,000 people1 have been affected by inappropriate injection practices over the past decade. However, the impact on some of the affected patients and facilities can be dramatic, including outbreaks of MRSA, hepatitis B, and hepatitis C.

A survey reported in the American Journal of Infection Control, found that 6% of clinical personnel questioned said they “sometimes or always” use single-dose/single-use vials for more than one patient. Other less frequently cited practices that are inconsistent with current guidelines included overt syringe reuse and use of a bottle or bag of IV solution for more than one patient. All reported infractions, by the way, occurred about evenly in hospital and non-hospital settings—outpatient cancer clinics, hemodialysis clinics, dental offices, pain clinics, and so on.

The survey concluded that a multifaceted approach would be needed to reduce or eliminate unsafe injection practices. Use of educational resources from the Centers for Disease Control and Prevention (CDC) and others, redesign of devices to reduce the risks of unsafe practices, surveillance and monitoring, and enforcement of those protocols and laws. In addition, the study recommends developing a culture where patients, supervisors, and peers are vigilant to make sure safe practices are followed and vocal in questioning health care providers to make sure injections are safe.